ORCHESTRA Delphi consensus: diagnostic and therapeutic management of post-COVID-19 condition in vulnerable populations
Year: 2025
Type: article
Abstract: OBJECTIVES: Post-COVID-19 condition (PCC) remains poorly understood, especially in clinically vulnerable groups. We applied the Delphi approach to drive recommendations for the diagnosis, management, and prevention of PCC in people living with HIV (PWH) and patients affected by rheumatological diseases (RD) and haematological malignancies. METHODS: On the basis of literature review, three areas of interest in PCC in PWH, haematological malignancies, and RD were identified: (a) features and risk factors; (b) diagnosis and management; and (c) prevention. A three-round Delphi anonymous survey consisting of 15 questions was conducted including 69 experts. Consensus was measured by the six-point Likert scale categorized into four tiers: strong disagreement, moderate disagreement, moderate agreement, and strong agreement. Statements were generated on questions achieving consensus. RESULTS: Eleven statements were generated: six on features and risk factors of PCC in clinically vulnerable populations, two on diagnosis and management, and three on prevention. Chronic fatigue was identified as the most frequent presentation of PCC in PWH and RD populations. A different case definition of PCC is required for RD population, as symptoms of PCC and autoimmune disorders may overlap. Risk factors for PCC include age >65, severity of COVID-19, and female sex; the latter is also associated with increased smell/taste impairment. A clinical assessment or a routine laboratory test performed 3 months after acute infection is not suggested to diagnose PCC in PWH. PWH and RD should be screened to exclude additional autoimmune disorders in case of chronic fatigue/arthralgia of new onset. Full-course vaccination and early treatment for COVID-19 should be promoted to prevent PCC, whereas corticosteroids during acute infection are not recommended. DISCUSSION: Diagnosis, management, and prevention of PCC are still under discussion. This Delphi offers valuable insights on PCC in selected clinically vulnerable populations and suggests a tailored approach in vulnerable populations.
Authors: Elisa Gentilotti, Lorenzo Maria Canziani, Maria Giulia Caponcello, Anna Maria Azzini, Alessia Savoldi, Pasquale De Nardo, Zaira R. Palacios-Baena, Beatrice Tazza, Natascia Caroccia, Giulia Carla Marchetti, Andrea Antinori, Maddalena Giannella, Jesús Rodríguez-Baño, Evelina Tacconelli, Alessandro Tavelli, Marta Camici, Roberta Rovito, Stefania Piconi, Antonio Cascio, Giovanni Pellicanò, Giordano Madeddu, Francesco Maria Fusco, Sergio Lo Caputo, Andrea Costantini, Fulvia Mazzaferri, Giada Fasani, Marcella Sibani, Maria Diletta Pezzani, Lorenza Lambertenghi, Michela Conti, Ruth Joanna Davis, Federica Calò, Caterina Campoli, Lorenzo Marconi, Luciano Attard, Paula Olivares-Navarro, María Isabel Sanchez-Gárcia, Ana Belén Hidalgo-Cespedes, Ioana Hrom-Hrom, Almudena De la Serna, Lydia Barrera-Pulido, Virginia Palomo, Chiara Dellacasa, Elisa Rossi, Salvatore Cataudella
Institutions: University of Verona, Instituto de Salud Carlos III, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla, Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Universidad de Sevilla, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Milan, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, University of Bologna
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,780
Funders: Cancer Research Institute, Johns Hopkins University, Universidad de Sevilla, Università degli Studi di Milano, Royal Free London NHS Foundation Trust, Amsterdam University Medical Centers, Ospedale Pediatrico Bambino Gesù, University of Cambridge, University College London, European Commission, University College Dublin, Institut National de la Santé et de la Recherche Médicale, Universiteit Leiden, Universiteit van Amsterdam, Cambridge University Hospitals, Università degli Studi di Milano-Bicocca, Karolinska Institutet, Sapienza Università di Roma, National and Kapodistrian University of Athens, Universidad de Buenos Aires, Università degli Studi dell'Insubria, Universidade de São Paulo, Universitat de Barcelona, Università degli Studi G. d'Annunzio Chieti - Pescara, Università di Bologna, Université de Bordeaux, Université de Lausanne, Centre Hospitalier Universitaire Vaudois, Universität Zürich, Università degli Studi di Torino, Universidade do Porto, Università degli Studi di Verona, Università degli Studi di Brescia, Pomorski Uniwersytet Medyczny W Szczecinie, Universitätsspital Zürich, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centre Hospitalier Universitaire de Bordeaux, Humanitas Research Hospital, Stichting HIV Monitoring, Horizon 2020 Framework Programme, Instituto de Salud Carlos III, Institute of Infection and Immunity
OpenAlex ID: W4409543749